Finding a Bulk Billing GP in Melbourne: Your Guide to Medicare and Low-Cost Care

Finding a Bulk Billing GP in Melbourne

Hi! As a General Practitioner (GP) in Australia, I know being unwell is stressful enough. The burden of worrying about how to pay for a doctor's visit or finding a bulk-billing GP in Melbourne can make your situation twice as bad.

I want to guide you through how our healthcare system works in elementary language. We will explore different options, starting from your usual doctor to what you can do when your clinic is closed. This is your guide to understanding Medicare, bulk billing, and getting the care that you and your family need.

Key Takeaways

• Bulk billing means your doctor's visit will cost you nothing. Your doctor bills Medicare directly and accepts the benefit as full payment.
• Not all medical centres offer bulk billing. It is the doctor's decision. Most clinics nowadays are in 'mixed' or 'private' billing mode, which means that you may be required to pay a 'gap fee' (an out-of-pocket charge).
• Finding a bulk-billing doctor is more difficult than before because the Medicare rebate (what the government pays us GPs) has not been increased to keep pace with the rising costs of maintaining a safe, high-quality clinic.
• There are ways to get affordable medical care by using the official Healthdirect Service Finder online and, most importantly, by phoning the clinic to inquire about their charges before your visit.
• After-hours clinics (like 13Cure) aim to offer medical care when your regular GP is closed. Most of these services may be bulk-billed to eligible patients.

What Do All These Terms Mean? A Simple Guide to Your Visit

When you go to a doctor, you might be told by the doctor or the receptionist some terms such as 'bulk billing', 'gap fee', or 'private billing'. It can be confusing, so let's break it down simply.

Your Medicare Card: Australia's Health Insurance

Let's first dwell on what a Medicare card is. The best way to describe it is to think of it as a national health insurance card. It is Australia's universal health insurance scheme, funded by us (taxpayers) through a 2% Medicare levy deducted from our taxable income.

The system is made to provide minimum or no-cost access to health and hospital services for all Australians and some eligible visitors. When you avail this service, it shows that your coverage is for a certain amount 'rebate'of many essential medical services.

Bulk Billing: Paying $0 for Your Visit

Bulk billing is the most straightforward way to see a doctor. In essence, your medical service hasbeen entirely covered. You have a doctor's visit and show your Medicare card, and the payment is waived.

What is undertaken "behind the scenes" is the doctor's agreement to accept the 'Medicare benefit', a fixed amount funded by the government, from the patient's perspective as the full payment for the medical service. The doctor is the one who sends the bill directly to Medicare, and therefore, you are not involved in the transaction. The term 'bulk billing' was derived from the fact that a practice bills Medicare for many services simultaneously, in 'bulk'. The only thing you should keep in mind is: bulk billing = $0 for you.

Private Billing: Understanding the "Gap Fee"

When a doctor bulk-bills, it's usually called 'private billing'. This is gradually becoming the dominant situation.

The following is the typical private billing scenario:

• The doctor sets their own consultation fee, which exceeds the Medicare rebate.
• You (the patient) are required to make the whole payment at the reception desk, most of the time, immediately after your appointment.
• Afterwards, the clinic will probably assist you with on-the-spot claiming of your Medicare rebate. The refund will be credited to your account.

The portion of money that you do not get back is referred to as the'gap payment' or 'out-of-pocket cost'. It denotes the difference (the 'gap') between the amount the doctor charged and the sum Medicare has refunded to you.

What is a "Mixed Billing" Clinic?

'Mixed billing' clinic has now become the most prevalent type of practice. Literally, it does both.

A mixed billing clinic could:

• Bulk bill some patients, e.g., children under 16, pensioners, and holders of Commonwealth concession cards.
• Privately bill other patients, for example, adults of working age without a concession card.

Additionally, they might alter their billing depending on the time of day. For instance, a clinic may bulk bill on weekdays while charging a private fee for all appointments on weekends. The primary reason for this is that the government provides bonus payments (referred to as the 'triple bulk billing incentive') to GPs for bulk billing children and concession cardholders. Although this assists those groups, it also means that clinics are more likely to charge a gap fee for other patients to help cover their running costs.

Who Qualifies and What Does Medicare Cover?

Possession of a Medicare card is the initial step; however, it is equally important to know who can get one and what your card can and cannot cover.

Who is Eligible for a Medicare Card?

Registration in Medicare is allowed to you if you live in Australia and fall under one of these categories:

• Australian citizen
• New Zealand citizen living in Australia
• Permanent resident of Australia
• Applicant for permanent residency (some conditions)
• Temporary resident covered by a special government order
• A visitor coming from a country that has a 'Reciprocal Health Care Agreement' with Australia

Does My Medicare Card Guarantee a $0 Visit?

This is the question I am asked most often. The straightforward answer is: No.

A Medicare card allows you to be bulk-billed; however, it does not compel the doctor to do so.

It is the doctor's decision whether to bulk-bill. A GP clinic is a small business. We are to pay for the rent of our buildings, the salaries of the reception and nursing staff, insurance, and medical consumables. Our choice of billing model depends on whether we can cover the costs with the Medicare rebate alone.

What GP Services Are Usually Covered by Medicare?

Medicare provides benefits for various services listed on the 'Medicare Benefits Schedule' (MBS), the official government list of covered services.

Some of the services covered by GP include:

• Regular consultations (In GPs ' GGPs ' GGPs'terms, this is an 'Item 23', which is a visit lasting up to 20 minutes) 
• Extended appointments for complicated health issues
• Designing mental health care plans
• Managing chronic conditions such as diabetes or asthma 
• Referrals to specialists
• Some blood tests, x-rays, and scans 
• Eye tests carried out by an optometrist 

What Important Services Are NOT Covered by Medicare?

It's equally important to be aware of what is not covered, as this can help you prevent "bill shock".

Some of the usual services which Medicare does not cover are:

• Ambulance services: This is the most important thing to know. In Victoria, Medicare does not cover the ambulance service. Unless you have ambulance insurance or it is included in your private health insurance, you will have to bear the full cost, which can be very expensive.
• The majority of dental care routine check-ups, fillings, and most other dental work is not covered by Medicare.
• Glasses and contact lenses: The eye test is usually covered by Medicare; however, the glasses or lenses are not.
• Most allied health services, such as physiotherapy, podiatry, or psychology, are generally not covered by Medicare unless your GP has you on a specific Chronic Disease Management plan, which provides a limited number of rebated visits.

Why Is It Getting Harder to Find a Bulk Billing GP in Melbourne?

If you think that it is more difficult to find a doctor who bulk bills than it was in the past, then you are right. Patients make such statements to us doctors almost every day, and we totally get your point of frustration. As a doctor, I believe healthcare should be accessible to all.

A Doctor's Perspective: Why Clinics Are Changing

The primary reason is that the Medicare rebate the amount the government pays our clinic for a visit has been 'frozen' or increased very slowly for the last several years. On the other hand, the costs of providing a high-quality, safe clinic have greatly improved. As for rent, which is very expensive in Melbourne city, we must pay for medical consumables and insurance, and we must also pay a reasonable wage to our reception and nursing staff.

When the rebate for a standard visit (about $43.90) no longer covers those costs, a clinic has to make a difficult decision. Either we are less able to spend time with each patient (which is not safe or healthy for you), or a 'gap fee' is introduced to keep the doors open. Most doctors choose the latter because they will not compromise the quality of the patient's care.

One of the most recent reports by the Royal Australian College of General Practitioners (RACGP) reveals that the majority of GP owners (81%) are concerned about the financial future of their practices.

The Cost of Care in Victoria: What the Numbers Show

This is not solely your intuition; the facts point in the same direction and show it as a real trend.

• Many clinics around Australia that used to be 'bulk billing only' have changed their status in the last couple of years.
• The typical 'gap fee' (your out-of-pocket expense) for a regular GP visit is currently around $39.
• This has a genuine effect on households. Almost one out of ten Australians (8.8%) in 2023-24 stated that they postponed or did not visit a GP when it was necessary due to the cost. As a GP, this statistic concerns me the most. Delaying care can turn minor health issues into significant problems.

It is also essential to recognise that this change does not affect people equally. The government has recently tripled the bonus payments for GPs who bulk bill children under 16 and concession cardholders. This has been very supportive of those groups.

On the other hand, most working-age adults do not benefit from this additional incentive. That is why you might find your child bulk-billed while you, at the same clinic, are charged a gap fee.

The 2024 data makes it crystal clear:

Sarah's Story: Sarah is a 32-year-old graphic designer from Fitzroy. She went to her local GP clinic, where she has been going for the last five years. Upon the receptionist's request to pay $85, she was utterly surprised. The receptionist explained to her that the clinic had gone into 'mixed billing'. Since Sarah is a working adult without a concession card, she has not been bulk billed anymore, although the clinic continues to bulk bill her mum (a pensioner). Sarah's 'gap fee' was around $41, and she is now worried about what she will do if she gets sick again.

Your Step-by-Step Plan to Find Affordable Care in Melbourne

Though it is more difficult, there are still opportunities to get bulk-billed or low-cost medical services. I present here a step-by-step plan.

Step 1: Use the Official 'healthdirect' Service Finder

The healthdirect site is a perfect place to start your search. It is a government-supported service featuring a 'find a health service' tool.

Working with this tool looks like this:

• Open a browser and go to the Healthdirect site.
• Find your health facility via the service finder, and type in your suburb or postcode (e.g., 'Carlton 3053')
• Choose the service you are looking for: 'General Practice'.
• Filter by ticking the 'Bulk billing only' checkbox.
• This will provide you with a list of bulk billing
• practices in your area.

Step 2: CALL the Clinic and Ask These Questions

This stage is the utmost one. An online directory is not always entirely up to date. A facility noted as 'bulk billing' may only bulk-bill some patients, e.g., children. To be on the safe side about billing, you need to call ahead.

Step 3: Ask Your Regular GP About "MyMedicare"

If you have a family doctor, you should discuss the topic 'MyMedicare' with them. My Medicare is the government's newest, free, voluntary program. It allows you to 'register' with the clinic of your choice, thereby indicating that the clinic is your primary healthcare provider.

So, why register? It provides your GP clinic with additional financial support to better serve you in the long term. It is also quite likely that registered patients will be offered access to longer telehealth (call or video)

What makes this telehealth particularly valuable is the government's anticipated bulk billing for these longer phone or video calls. By November 2025, this extension of bulk billing will be available to all registered patients, enabling longer consultations. For registration, just consult your clinic's reception crew; the process is relatively easy.

What About When Your GP is Closed? Accessing After-Hours Care

Sickness doesn't wait for office hours. If your regular GP is closed, here is what you can do.

What is After-Hours Care?

Your GP is entitled to rest, too! The 'After-hours' period is when most regular clinics are closed. This is

• Before 8:00 AM and after 6:00 PM on weekdays
• Before 12:00 PM on Saturdays
• All day on Sundays and public holidays

Such care is meant for urgent health problems, things that can't be put off until the following day, but aren't serious emergencies.

Please, for any emergency, such as chest pain, if you experience severe breathing difficulty, or significant bleeding, you should always call 000.

How 13Cure Provides After-Hours Support in Melbourne

13Cure is a non-contracted after-hours medical service that provides support to Melbourne residents when their regular GP is unavailable. We offer this assistance in two significant ways: telehealth visits (by phone or video) and a home doctor visit. Our service is meant to complement your regular GP. After your session, we send a letter to your GP to confirm that continuity of care is maintained. Patients holding a valid Medicare or DVA card may get free home visits through our after-hours program. There are also telehealth options.

You can book your after-hours appointment online or by calling 13CURE (132873), using the 13Cure app, or via our website.

Conclusion

Hopefully, this guide has been instrumental in clearing up the confusion that surrounds Medicare and bulk billing in Melbourne.

We are dedicated to providing high-quality medical care during the hours when most other clinics are closed.

As a GP, the best advice I can give is to find a family doctor or clinic that you can rely on. The long-term relationship is the most valuable thing you can do for your health.

The first step to making the system work to your advantage is to understand how it functions. At no time should you feel apprehensive about phoning a clinic to inquire about their charges; it is a perfectly normal and fundamental question. Your health is always the first thing.

Moreover, even if your usual clinic is not operating, there is still help for you and your family.